The American College of Prosthodontists (ACP) ended 2015 by publishing new guidelines about the care and maintenance of dental restorations, including both restorations that are supported by natural teeth and those that are supported by dental implants.
Although there is nothing startling in these care guidelines, it is good to have them consolidated and get a sense of the evidence supporting the various recommendations.
The new recommendations follow recommendations that have been in place for a long time. When it comes to making visits to the dentist, the ACP continues to recommend 6-month recalls for the care and maintenance of dental restorations such as porcelain veneers, dental crowns, and dental implants. It notes that dentists should clean the restorations and the natural teeth thoroughly, and always remember to use tools appropriate to the restorations.
For home care, the ACP notes that people should brush their teeth twice daily and that they should use dental floss, flossers, water cleaners, or other methods to supplement the removal of debris and plaque from between teeth and around the gum line.
For people who have “multiple and complex restorations on existing teeth supporting or surrounding the removable restoration,” the ACP recommends a high-fluoride toothpaste with the addition of triclosan antibiotic and the use of chlorhexidine rinses.
Perhaps the biggest revelation in the ACP’s guidelines is that few of the clinical care recommendations are really supported by good science. As is normal with clinical care guidelines, the quality of evidence is rated A, B, C, or D. Most of the guidelines that the ACP has issued are rated “D,” which means they are directly based on or extrapolated from lower-quality evidence. The only recommendations rated “A” include: getting a thorough exam from your dentist (but not the frequency of those exams), brushing and flossing twice daily, and the additional care guidelines for “multiple and complex restorations.”
The generally low quality of evidence doesn’t mean we shouldn’t follow these recommendations, they seem to be right based on the evidence we have. But perhaps if we do more research, we will get better information.